Episodes Of Acute Respiratory Tract Infections Research Articles

Antibiotic treatment of respiratory tract infections in adults in Norwegian general practice.

To analyse the prevalence of respiratory tract infection (RTI) episodes with and without antibiotic prescriptions in adult patients in Norwegian general practice during the period 2012-2019. Observational study linking data from the Norwegian Control and Payment for Health Reimbursements Database and the Norwegian Prescription Database. Episodes of acute RTIs in patients aged 18 years or older were identified and linked to antibiotic prescriptions dispensed within 7 days after diagnosis. We analysed annual infection rates and antibiotic prescription rates and antibiotics prescribed for the different RTI conditions. RTI episode rate per 1000 inhabitants was 312 in 2012 and 277 in 2019, but showed no linear trend of change during the study period (P = 0.205). Antibiotic prescription rate decreased from 37% of RTI episodes in 2012 to 23% in 2019 (P < 0.001). The reduction in prescribing was most pronounced for episodes coded with ICPC-2 symptom diagnoses, as well as upper RTIs, influenza, acute bronchitis and sinusitis. Prescriptions for phenoxymethylpenicillin decreased from 178 746 in 2012 to 143 095 in 2019, but increased as proportion of total antibiotic prescriptions from 40% in 2012 to 53% in 2019 (P < 0.001). This study demonstrates stable RTI episode rates and reduced antibiotic prescription rates for RTIs for adults in Norwegian general practice 2012-2019. We also observed a shift towards relatively more use of phenoxymethylpenicillin and less broad-spectrum antibiotics. These changes are in line with the aims of the Norwegian strategy against antibiotic resistance.

Antimicrobial use for pediatric acute respiratory tract infections and the subsequent emergence of multi-drug resistant bacteria

Background: Viruses cause the majority of acute respiratory tract infections (ARTIs). On clinical grounds, differentiation of bacterial vs. viral ARTIs is difficult and warrant costly investigations. In Sri Lanka, ARTIs are commonly treated by family physicians (FP), and severe patients seek inward care. This study was conducted to evaluate the use of antibiotics by FP and by hospital care and the development of antimicrobial resistance (AMR) in children with viral ARTIs. Methods and materials: Nasopharyngeal aspirates of inward patients (1-month to 5-years) with ARTIs were collected in Teaching Hospital, Anuradhapura from March-2013 to August-2014. Using immunofluorescence assay (IFA) specific viral etiology was detected. Phenotypically multi-drug resistant (MDR) bacteria were detected. The use of antibiotics and the development of infectious diseases in the past six months, in the current episode and follow up to 6 months was assessed using questionnaires, telephone interviews, and demonstration of antimicrobials. Multivariate analysis was performed to assess risk factors for the development of MDR microbes. Results: Out of 413 viral etiologies were detected in 40% (165/413). Antibiotics were prescribed in the health care facility for 100% (165/165) of patients with viral ARTIs. Initially, 120 patients were treated by FP, and 100% were on antimicrobials. Following admission, 84 of them were treated with antibiotics. Out of 120, 80 were on co-amoxiclav, 38 were on cephalosporin (cefixime-28; cefuroxime-10), and 2 were on macrolides monotherapy. Everyone was presented to FP on day 1 of illness. Mean ± SD hospital stay for viral ARTIs with and without antimicrobials was 4 ± 1.6 and 4.1 ± 1.8 days and is not significant. Eighty had two episodes of ARTI in the earlier 6-months, and every occasion was treated with antibiotics by FP. In follow up, 102 (75%) and 20 (14.7%) extended-spectrum of beta-lactamases (ESBL) and carbapenemase producers (CRE) were isolated in patients with urinary and other infections. Conclusion: The use of viral diagnostic by FP and in hospitals would be an essential factor in reducing the unnecessary use of antibiotics. The rational antibiotic use will invariably contribute to reduce the cost and to prevent the emergence of ESBL and CRE.

English

BACKGROUND: Acute respiratory tract infection (ARI) is major cause of morbidity and mortality in children under 5 years of age especially in developing countries. Hence the present study was undertaken to study the incidence and determinants associated with ARI. AIMS: To study the incidence and determinants of ARI in children aged less than 6 years. SETTINGS: The present study was conducted in rural setting of Pune district where in 118 children between 0 to 5 years were interrogated as per predesigned proforma. METHODS: All 118 children were followed up every month for a period of 1 year and interrogated for incidence and various risk factors. STATISTICAL ANALYSIS: Chi square test was used. 'P' value < 0.05 was taken as significant. RESULTS: A total of 199 episodes of ARI (174 of AURI & 25 of ALRI) were present among all children. Incidence rate of ARI, AURI, ALRI was 1.69, 1.47, 0.21 episodes/child/year. Malnourished children had higher incidence as compared to nourished children. (2 episodes/child/year Vs 1.50 episodes/child/year). Association was found between incidence of ARI and immunization status, seasonal variation and various environmental factors. CONCLUSION: The present study has identified incidence rate, various socio-demographic and environmental risk factors which can be tackled by effective education of mother, family & community and initiatives undertaken by government.

Morbilidad y Mortalidad durante el Primer Año de Vida en Pacientes con Síndrome de Down

ABSTRACT Down’ Syndrome Patient Morbidity and Mortality during the First Year of Life Objective: Down’ Syndrome (DS) is the most common chromosomal abnormality. It carries an increasedrisk of concurrent congenital malformations as well as increased risk of mortality when compared to thegeneral population. Objective: To determine the characteristics of morbidity and mortality in patients withDS during the first year of life. Patients and Methods: A prospective study of a cohort of children born withwith DS was performed. All children born in 2006 in two Chilean hospitals who were given a clinicaldiagnosis of DS were included. Infant mortality, morbidity and nutritional diagnosis were determined andrecorded every two months. Results: 33 patients were included, 78.8% were full term newborns. Averageage of the mother at childbirth was 33.2 ± 7.8 years. Among the 33 patients, 64.5% had congenital heartdisease, the most common cause being atrio-ventricular defects (25%), 35% of the patients with CHDrequired cardiac surgery. Gastrointestinal disorders were diagnosed among 35% of these children, atresiaor intestinal stenosis being the most frequent diagnosis. 25.8% of the population suffered fromhypothyroidism. Follow-up showed that after two months, 54.8% of these children were malnourished,however at one year old, 22.5% were overweight. By the first year, children had shown 5.38 ± 1.83 episodesof Acute Respiratory Tract Infections per patient per year, and 1.22 ± 1.14 non neonatal hospitalizations perchild/year. Half of these hospitalizations were due to lower respiratory tract infection. Two patients diedduring the study due to infectious disorders, resulting on a survival rate of 93.6% at 12 months.

Recurrent Human Rhinovirus Infections in Infants with Refractory Wheezing

Recurrent Human Rhinovirus Infections in Infants with Refractory Wheezing

The Epidemiology of Acute Respiratory Tract Infection in Young Children: Comparison of Findings from Several Developing Countries

Investigators from 10 countries studied the epidemiology of acute respiratory tract infection (ARI) among children 0-59 months old. Data on incidence rates, by age, gender, and season; on pathogenic agents; on case-fatality rates; and on selected risk factor findings are presented. Incidence rates from six of the community-based studies ranged from 12.7 to 16.8 new episodes of ARI per 100 child-weeks at risk, and rates of lower respiratory tract infection (LRI) ranged from 0.2 to 3.4 new episodes per 100 child-weeks at risk. Children spend from 21.7% to 40.1% of observed weeks with ARI and from 1% to 14.4% of observed weeks with LRI. The incidence rates for ARI are highest in younger children. Viruses, especially respiratory syncytial virus, are isolated more frequently than bacteria from children with episodes of LRI. Risk factors exhibited different patterns of association with ARI in different studies. Interventions could have great impact on high-risk levels common in the study populations. These studies provide interesting and useful data on the epidemiologic dynamics of ARI.

Epidemiology of Acute Respiratory Tract Infections Among Guatemalan Ambulatory Preschool Cbildren

Acute respiratory tract infections (ARI) were studied during a 2-year period in 521 preschool children living in a marginal area of Guatemala City. There were 3,646 episodes of ARI detected during 26,329 child-weeks at risk, for an incidence of 14 per 100 child-weeks or 7.2 episodes per child per year. The median duration of ARI episodes was 11 days. The highest incidence of ARI was observed in children 6-23 months old. Boys had more respiratory tract illnesses than did girls; the presence of a cigarette smoker in the household was associated with higher morbidity. Acute lower respiratory tract illnesses (ALRI) were more common among younger infants 0-5 months old, with nutritional status having no apparent effect. Parental formal education and crowding in households were found to be directly related to the incidence of ALRI. In general, ARI morbidity interfered with appropriate physical growth.